Erection problems are very common, most men can expect them to happen many times during their lifetime. However, they can be distressing, and sometimes the sign of other health problems.
I am asked about erection problems a lot, so have written a guide called Erection Difficulties Explained (downloadable from this link) to help you or your partner understand why erection problems happen, how to try and fix them yourself, when to seek help, and what happens if you see a doctor or therapist.
If you have erection problems it can be reassuring to know that you are not alone, and you can hear men speaking frankly to me about living with erection difficulties in the documentary ‘Impotential’, created with Loftus Media for BBC Radio 4. You can listen to this 30 minute programme here.
Are local or global situations causing you to feel distressed or anxious? Perhaps you’re at direct risk of social unrest, disease epidemics, terrorism, conflict, or police violence. This might be a recent emergency, or represent historic and systematic abuse and neglect. You may be being specifically targeted because of your race, gender, disability, sexuality, faith, or other factors beyond your control. You may have had some forewarning about events -or they may have come as a sudden shock. The threats you’re facing may be in the form of immediate financial, physical or emotional harm. Alternatively, it may be exposure to events via the media, through conversations with friends, or awareness of world events that are making you feel unhappy or afraid. If you already have an existing physical or mental health condition this may be exacerbated by knowing about other hazards that could be affecting you – or those you love. Maybe you aren’t even immediately familiar with people facing maltreatment but you are still distraught on hearing about their situation and wish to do something practical to help.
Below are a number of resources for you to use to help yourself, or to share with others who might benefit from them. All are designed to be adapted to suit different circumstances depending on where you are and what the problem(s) are that you are facing.
The Black Cross Health collective have specifically designed resources for those providing first aid during protests, demonstrations and periods of unrest. The BBC have produced these resources for First Aid in Hostile Environments, while the International Red Cross have produced First Aid in armed conflicts and other situations of violence available in multiple languages. Hesperian have a range of health guides in multiple languages on a variety of health and development topics for those who lack access to affordable and accessible services. Their most famous text Where there is no doctor may be essential to you or your community in emergency situations. Mental and physical health resources are also linked to alongside personal care and safety materials in What to do instead of calling the police (this is more of a US-focused guide but may still be adaptable to other country settings). In general the advice for anyone at risk of physical harm or with health problems is to call the emergency services (fire service, paramedics, police, or coastguard). Noting, also, that these may not be available – or that you may not feel you can trust such services.
It’s common during and after a crisis to not know what to do or feel so weighed down by events you cannot concentrate or care for yourself or others. These two guides may help. The first is from me, writing in the Telegraph, about how to cope when life seems frightening and upsetting the other is by therapist Tania Glyde on When the world has changed forever – self care in a collective crisis. Both of these posts provide ideas for tackling loneliness, isolation, fear and distress – with links to additional sources of support and help. They are particularly focused on those who are living in times of uncertainty or unrest.
Meanwhile, regardless of wider social or cultural situations happening around you, other life events can also keep on happening. These might be positive or negative – but you may still require assistance in coping with them – in which case a list of support services and helplines can be found here.
I recently made a podcast and wrote about how agony aunts can play a role in times of crisis, poverty and austerity to reflect back to wider society how these issues impact on people’s lives. This fits within a broader narrative of the advice column/programme being both a positive source of help and a place of activism and change.
Unfortunately, not all advice giving is like this. As with any medium it has its faults and limitations. Moreover advice giving may actually cause harm. Not just because the information shared is outdated or wrong. But because of how it represents treats already marginalized groups or individuals and plays into the hands of politicians and media outlets that wish to sideline and stigmatise them further.
This is explained very clearly in a paper by Dr David Hill from the Department of Communication and Media at the University of Liverpool entitled Class, Trust and Confessional Media in Austerity Britain that focuses on the UK television programme The Jeremy Kyle Show. Jeremy Kyle is part of a stable of what may be called ‘Talk Television’, ‘Confessional Television’, ‘Tabloid Talk’ or ‘Tabloid TV’ shows; that are popular across media particularly in the UK and US and include programmes such as Maury, Oprah, Dr Phil, Jerry Springer and more. (You can read more about these programmes within a wider global history of television advice giving here). Over the past 20+ years these programmes have moved from being discussion-based and issues driven, modeling a therapy session, and often aimed at individuals and audiences largely excluded from mainstream services; to a more confrontational, aggressive and shock-based format.
The general style for Talk TV currently, including The Jeremy Kyle Show, involves bringing members of the public together to discuss personal problems, relationship difficulties and family issues in front of a live studio audience. Where the host acts as referee and judge and where (for some programmes) additional support services/counseling may feature, delivered by a regular or occasional guest therapist, life coach, self-help guru or similar. Although possibly perpetuating some of the problems highlighted in Hill’s paper. This short clip that brings together popular narratives within The Jeremy Kyle Show for those who aren’t familiar with it.
Advice giving in print and broadcast media have been analysed through various lenses – including health, gender, media and cultural studies and history (see more here http://nostartoguideme.com/resources ). Hill takes a class-based approach to claim “the function of The Jeremy Kyle Show is inextricably bound up in a neoliberal agenda towards rolling-back state apparatuses and expenditure, while simultaneously shaming those who depend on it or have refused, for whatever reason, the mantra of self-help, in what has come to be called Austerity Britain – predating the financial crisis and yet prefiguring supposed solutions to it” (p.2).
As with other Talk/Tabloid TV programmes, The Jeremy Kyle Show utilizes ‘science’ as part of the means of addressing guest problems. These include televisually attractive and dramatic interventions such as lie detectors, drug and paternity tests. Hill highlights how these devices are used as “technologies of confession” (for example to root out those who have been unfaithful, or who have stolen from other family members). Hill argues that while Talk TV is “a training course in middle class culture, and in the case of talk shows this can be understood as training in the talking cure” (p.4) the additional inclusion of other technologies implies whatever guests say, their word alone cannot be trusted.
In turn, this reminds the audience in the studio and at home, to distrust people. Where liars can be exposed via science, and caught in their deceit. This is often noticeable when a person passes one question on the lie detector test but not the other – a situation that’s used to highlight the greater truth of the polygraph. As if the person who took the test agrees with one of the results they must accept them all. The test, we are told, cannot be right on one thing and wrong on the other. Arguing with the test results (and with Kyle) is taken as a further example of untrustworthiness. Since the majority of guests on the programme (and ones like it) are poor, working class, and in the case of US programmes Black or Latina, the underlying message is ‘these people cannot be trusted’.
Hill, again building on the work of other media scholars (cited within the paper) looks at how within the paternity/DNA testing the message is given that working class women not only deliberately mislead potential fathers but often are so feckless about their own sexuality they may not even know who the father of their child is. Hill’s focus on The Jeremy Kyle Show illustrates how working class mothers are portrayed as untrustworthy and sexually loose. While working class fathers are irresponsible sexually and financially – if they are not supporting any child they may have had. This may be more acutely observed on programmes like Maury that specialize in women coming back for multiple paternity tests where man after man is revealed not to be the father of their child. Men’s reactions to this news – often in the form of cheering and dancing reinforces, alongside the mother’s behaviour, the idea those who feature on the programmes are sexually immoral, lazy and irresponsible. Again as the majority of said guests are poor, and commonly Latina or Black the core message becomes ‘here are people who do not care enough about getting pregnant or supporting their children’. Views that are often reinforced by comments shouted by audience members or made by guests to each other as they argue prior to and after hearing the DNA test results.
Drug testing may be used separately or paired with either the lie detector or paternity testing. Its use, as argued by Hill and others (cited in the paper) suggests how drug/alcohol abuse is part of working class culture and as evidence of how working class people do not know how to look after themselves properly (see p. 7). In many cases having found someone has been using drugs or alcohol (and often after proving they’ve ‘lied’ about this) for additional televisual drama the person is requested to choose whether to accept help or not. On The Jeremy Kyle Show this is often illustrated by guests seeing a film of a car arriving at the back of the studio that they are told will take them to a recovery clinic. The guest with the drug/alcohol problem is begged by their relatives/friends/studio audience/host to get into the car and seek help. Often with the suggestion if they do not accept this they will not get the opportunity again. Guests who refuse help are made out to be irresponsible and uncaring about themselves or their wider family, children etc.
Although Hill’s paper doesn’t extend to other media, this kind of approach is played out frequently within media advice giving in print and broadcast formats where a ‘correct’ narrative of ‘staying healthy’ is rehearsed. Eating fresh fruit and vegetables, drinking plenty of water, exercising, ensuring you’re not overweight, not smoking, seeing the doctor if you spot any symptoms, taking your medication. All of these things are a set pathway to health. Straying from that pathway or doing things that might cause additional problems to your mental and physical health (e.g. staying in an abusive relationship, self harming, not talking to people about your worries) are all taken as examples of people not looking after themselves. Usually (and incorrectly) associated with the out-groups highlighted above. And coming with restrictions and caveats attached. You can have advice, but only if you act on it. You can get help but only if you follow it immediately and unquestioningly. If you take your time, relapse, or don’t do as you are instructed this becomes your fault for which you can expect to be blamed, shamed or in some cases sanctioned.
In the second part of his paper, Hill explores how the use of technologies fit within a climate of austerity. One area he discusses will be familiar to those who are agony aunts or uncles, which is advice giving within media is an alternative to existing, mainstream services. As services are cut and restricted and as demand for them increases, having alternative places to ask for help and get support – or in the case of The Jeremy Kyle Show have paternity and drug/alcohol testing and treatment – means the state (primarily in the form of the NHS) does not have to pay. Rather than this supporting existing, struggling, services Hill highlights an alternative reading of Talk TV programmes. “[W]ith the welfare system now deemed largely unaffordable and in need of dismantling…and volunteerism and private enterprise seen as part of the solution…this commercial television production can be read as a sort of perverse public service, auditing fiscally unviable bodies in order to shame them for their burden on the nation” (p.9-10).
The role of Kyle as presenter/host is also interrogated within Hill’s paper (which also cites other research that has performed similar analysis of the role and behaviour of Talk TV show hosts). Kyle takes on the role of judge and commentator, who is the cipher between the guests, audiences and any tests used. He not only delivers the results of any testing but passes comment on the results and people’s reactions to them. With follow-up questions that ask about people’s employment, income, mental health, physical wellbeing, sexual history and so on. All of which may be used to further shame or blame them for whatever situation has brought them to the programme. Where guests are using benefits but also have had children or are using drugs/alcohol Kyle makes a point of this as further evidence of people’s lack of trustworthiness, dishonesty and laziness: “[i]t plays to stereotypes of unemployment, alcohol or drug consumption and pregnancy as lifestyle choices for ‘feckless chavs’ who are ripping off Britain via the welfare system” (p.11). Within this “The Jeremy Kyle Show is simply about fire-fighting failure, where the narrative is not so much that everyone can be a success, but simply that everyone can and should be less of a financial burden to the state. The show, then, adopts state practices of roll-out, measuring the value of individuals, in order to promote the roll-back of state expenditure and apparatuses. So, it is that Kyle presents as an austere judge in a court of austerity” (p.11-12).
How can we use research like this?
We can use papers like Hill’s to help us see more clearly how programmes are constructed, perhaps noticing for the first time ways that people might be helped or disadvantaged by broadcasting styles and formats. It might enable us to question who is included or excluded by Talk TV (or advice giving more widely) or to notice that agony columns or programmes very often sit alongside or support particular views about life, help seeking, care and problem solving. Identifying this and considering how it might impact on our own lives or professional practices can be very useful.
Therapists and health care providers may well notice how their patients may have incorrect beliefs about what therapy, or drug/alcohol care or paternity testing might entail having watched programmes like The Jeremy Kyle Show. Being mindful that this may frighten away would-be patients who might benefit from help/care, or give them the view that therapy will be instructive, judgemental and revolve around scientific testing (which may or may not be what a client might want) could help people access care more effectively and realistically. A useful exploration of this can be found via Jonathon Tomlinson’s blog post Who is the NHS for? Not me!
If you are an agony aunt or uncle or work in media advice giving
You may want to consider whether the advice you give also fits within the kind of format outlined by Hill’s piece. What role do you occupy as an advice giver? Are you presenting yourself as a judge? Do your editors and/or audiences want this – and if so how does this help them (and you)? Do you use advice giving to discourage people from seeking particular sources of help, blame them for doing so or suggest if people have problems in one area (e.g. they’re an alcoholic) they do not deserve help in another (e.g. access to healthcare or benefits)? Perhaps like many other people you’ve taken on board a lot of the messaging within Talk TV about self-reliance, associating state benefits with shame, or judging those who do not ‘help themselves’. If so, how might this affect the advice you offer others? At what point do discussions around self-determination, self-care and personal empowerment become messages about scrounging, and problematizing the use of benefits people are entitled to. Given some of the political strategies around the shaming of those who have disabilities or claim benefits in order to make cuts to services and support, where is your advice fitting in? Are you inadvertently or deliberately ensuring that some people are demonised by the advice you give, and do you encourage your viewers/readers/listeners to side with you against them? (For more on what the extreme consequences of this can be, reading more about radio and advice giving during/after conflict may be necessary).
It may be you disagree entirely with the analysis presented in Hill’s paper or how I’ve interpreted it here. Perhaps you agree with the interpretation of Talk TV programmes but simultaneously think there is a role for shock media where people’s problems are performed as entertainment and where those who do not fit appropriate behavioural models deserve to be given a ‘wake up call’. You may favour ‘straight talking’ advice in your columns or programmes. In such a case can you reflect on what services you are offering and think about if your approach is still helping people seek appropriate care when needed?
Because of the framework of analysis used within Hill’s paper, it does not concern itself with whether or not the approaches taken in The Jeremy Kyle Show ‘work’. For all the tests, technologies, a focus on ‘telling it like it is’ and referrals to aftercare, there remains little evidence of the effectiveness of Talk TV programmes around addressing people’s problems with their mental or physical health, addictions, relationships problems, financial or childcare worries. Whatever kind of advice we are offering, how do we know it is right? How do we know it is effective? Are we working to a standard of ‘first do no harm’? If so, how can we be sure that we aren’t directly or indirectly causing problems? And if not, why are we wanting to adopt a model of advice giving that is potentially harmful? Although Hill does not ask us these questions, my reading of his paper suggests that we should still be thinking about them.
Applying this work
There are several ways in which papers like Hill’s can be used. They can help us reflect on the television we watch, to think about how it is made, how it encourages us to respond, and what can happen as a part of that process.
They can show us how programmes that present as a source of help and care may not always be doing this. And in fact may be causing indirect harm by presenting unhelpful and biased views about people in crisis. Not to mention taking advantage of those who may be vulnerable.
Using media for advice giving is more than offering help/signposting/support to those who’ve immediately reached out to us. Agony aunts and uncles could consider how our messaging, the problems we choose to focus on, and the way in which we offer advice/solutions all inform wider audiences and political landscapes about who deserves help and who does not.
The Jeremy Kyle Show and others like it portray a particular set of problems/situations, familiar narratives of easily identifiable ‘goodies’ and ‘baddies’ and an extreme form of self-reliance/individualism where those who are unable to cope alone are constructed as failures. Yet for many people who do not have access to health or social care, for whom counseling is alien and unaffordable (or at the end of a 6 month waiting list) Talk TV is a desirable option. If you cannot access or afford care, if you do not know what it might look like, then you may well reach out for a programme that offers scientific solutions and definitive judgements. Plus a trip away from home, the chance to be on television, and being put up in a hotel. If we are offering any kind of advice giving, noting why it may be attractive is important. As is recognising that because we provide advice, or a hotel, a fee, or a resource this doesn’t excuse people being maltreated on our watch or render what we do beyond reproach.
What Hill’s paper has reminded me is the importance of noting if services are not available, rather than using advice giving simply as an alternative to overstretched facilities we should be using it as a campaigning device to identify not just the needs of people currently unmet by health or social care, but to look deeper at the root causes of their problems and begin to try and address those directly. The next question, then, is how do we do this?
In a recent podcast in the Lancet Psychiatry discussing advice columns, Anna Raeburn noted the demise of the magazine advice column, alongside the decline of advice giving on radio (at least in Western countries).
This has been known for some time, but is put into context by this 2001 historical piece from Barbara Jacobs in The Guardian. Documenting the ending of a contract for the last in-house magazine agony aunt, Gill Cox from Woman’s Realm/Woman’s Weekly. Jacobs highlights the shifts in print media just as changes to online media are beginning. Which in turn both opened up and closed down opportunities for advice giving.
A link to the whole piece can be found at the end of this post. But noteworthy passages from it, included below, tell us a lot about what advice columns were worth to readers. Reveals the integrity of the advice column. Yet how little they eventually meant to editors and corporations. Cox and Jacobs note:
“The agony aunt is the social barometer of a publication, able to feed into editorial conferences her perceptions of the changes in mores. She is the link with the readers. “The job of agony aunt is part education, part entertainment,” she says, “and the balance of these two elements is what differentiates the gifted, gut-feeling journalist from the rest. But it’s more than that. Readers talk, we listen. Their issues become our features and campaigns.”
“We stamp our personality on the print. We’re the public face of the magazine or newspaper. With a staff agony aunt, the magazine or newspaper offers integrity in its approach. There’s none of that conflict of interests that is sometimes apparent where freelancers are employed, between the tone of the page and the content of the reportage”
“[t]he nature of the game has changed. The office desk for social conscience has been cleared, and in its place is a database, operated by a researcher trying to make sense of the desperation of the voiceless reader and dispatching it to a freelance, free-floating agony aunt over the internet. Personal solutions to personal problems, it seems, have become a thing of the past”.
For those who are interested there is research to be done on the advice column archives of women’s magazines – what were people asking about and what advice were they given? Alongside interviewing those who oversaw said columns or worked on them as secretarial support, and noting the changes to media within the past 40+ years, plus how the ‘personal solutions’ were offered. Not to mention interviews with editors and owners of publications to identify what strategic and commercial decisions led to the axing of in-house advice columnists and support staff – and the impact that may have had on audiences. Has the internet stepped into the gap left behind? Have the ‘freelance, free-floating’ agony aunts offered the same level of service? Is this 2001 piece more about the anxieties of print media in the face of the internet changes that were set to destroy a lot of traditional journalistic practice? Or is it a genuine call for improved services and reader care?
Others who are giving advice may want to reflect on what has changed, note the history of who has done the job before, and consider what we can do to bring in the ‘personal solutions’ in times of financial cuts and a lack of investment in the advice giving service. Again some of this is discussed in the podcast linked to at the start of this post.
In this month’s Lancet Psychiatry I’ve written a comment piece Agony, misery, woe: a new role for media advice columns about the history and purpose of media advice giving, the changing role of the agony aunt/uncle, and the agony aunt as witness to the crisis around austerity and poverty and the harms these bring.
Expanding on the comment piece I am joined by Lancet Psychiatry Editor Niall Boyce and journalist Anna Raeburn in a podcast where we talk about how advice giving has changed (or not), what it can deliver, and why practitioners may be missing this important media resource and the tools and experiences it may hold.
Anna starts the podcast talking about how advice columns have developed, with a particular focus on radio and the power of the voice in reaching out to others. In addition Anna touches on the problems posed to modern media due to financial cuts and a lack of investment in community programming/features and particularly local radio and press. Explaining that the need for advice and information is higher than before but the opportunity for advice givers to work effectively is “significantly less”.
From this Anna moves to talk about advice giving as storytelling, sharing experiences, and how it’s okay to say you aren’t sure about a person’s situation. While discussing the strengths and weakness of advice giving on television, newspapers, magazines and new media.
When asked what role agony aunts fulfill, Anna replies: “I would describe myself as a bridge….I have a very modest idea of what I can do. I want you to walk over me to the next stage of your life….I want, very modestly, to move you one step on from when you called me”
This is helpful in the context of advice giving as it sets out very simply what advice giving can achieve. And highlights where it may be a bridge between individuals and services but also part of a wider chain of help seeking behaviours people engage in. We don’t assume agony aunts have all the answers, or advice columns can solve all our problems, but if we consider it as a small step forward it reminds us that advice columns should never be excluded or forgotten about in wider conversations on physical or psychological health, help seeking or behaviour change.
In the second part of the podcast Niall asks me about evidence and whether we can we be evidence based around advice giving? This echoes other questions I’m increasingly asked about how agony aunts know they are doing a good job – something I’ll be returning to in future blog posts.
I reflect in the podcast on what agony aunts and audiences think evidence means when it comes to media advice giving. Plus what we already know about media advice giving, what we don’t know, and where we can draw parallels of evaluated work on self-help and public health campaigns. I have a bit of a grumble about how academic and journalistic snobbery can lead to advice giving being overlooked or denigrated – and why this is improvident.
For me the crux of the podcast focuses on the issue of how cuts to benefits, austerity measures, poverty and funding problems within the NHS are leading to staff and patients/service users feeling increasingly pressured, distressed and excluded. This may be an area where agony aunts and mental health services might work together, particularly in poor communities who are far less likely to be able to access and use mental health services. Another agony aunt Denise Robertson had previously suggested to me one role of the agony aunt in modern times was to bear witness to the damage caused by poverty, inequalities, and the blaming and shaming of those in need. The podcast explores more on why this has happened and whether there is a role for advice columnists and NHS staff and patients to work together to highlight theses issues and consider possible solutions.
This brings us to what form advice might take and how the traditional focus of the advice column has often been to refer people to a charity or a GP (Family Practitioner/Doctor), or helpline. But how in these cash-strapped times people are arriving at their conversation with advice columnists by telling them what services they have already tried – and failed – to access. The podcast reflects on why this is and what we might do about it in ways that do not further denigrate either those in need or health/social care staff who are also under huge pressure and struggling to do their job.
Rather than just seeing advice giving as asking for help, reaching out or being supported by others the podcast considers advice giving as advocating models of activism and resistance using the example of Focus E15 Mothers campaigning for housing and rights.
By contrast examples from the global south where advice giving through radio, TV, text and newspapers has had particular success are shared as examples of good practice. Particularly around the ideas of citizen journalism and self-care. I talk about trailblazers such as Hesperian and BBC Media Action within this context (although other examples of good practice can be found within this site).
The podcast ends with a reflection that if services across media, health and social care and the third sector are massively stretched. And where there is no immediate change to the current climate then we need to think about ways to help ourselves
“No-one is going to help us at the moment. That’s quite obvious. So how do we help ourselves and what do we do together to make things a bit easier for those in need where there may not be immediate help available?”
The resources below are ones I use myself within these limitations, and may help those who want to know more about working effectively where barriers exist.
Although broadcast after this podcast the actor Michael Sheen also picks up on some of the problems around the NHS and ways for us to defend and stand up for it.
Psychological First Aid, or PFA, may not be a term you’re familiar with, but it may well be something you’ve given or received. The Australian Psychological Society explain it as a “humane, supportive response to a fellow human being who is suffering and who may need support”. And while developed for people who’ve survived disasters (floods, fires, war, forced migration, earthquakes, mass shootings, or disease) it is effectively a set of tools that may benefit anyone who has experienced trauma. That may include civilians of all ages, journalists, healthcare staff, aid workers or others dealing with disaster.
The aim of PFA is to appropriately respond to another person’s needs to help them, when needed, at any point following a traumatic event. That may be around enabling them to feel safe and supported immediately after a disaster, allowing them to talk if they want to, and to reduce distress at any point following trauma. Importantly the point of PFA is to help people identify what services and facilities may benefit them during and after a crisis, enable them to connect with social support, assist them to feel in control, and empowered to try and recover from what has happened to them. Rather than telling people what they should do or how they ought to feel, the aim of PFA is to allow people to prioritise and address their own needs in their own time.
Following large and small-scale disasters we may focus on the physical injuries and deaths that may occur. We may not consider the impact of trauma on individuals who have lived through an event or the effects this may have on those who are front line or support service staff. PFA is used here to both reduce the likelihood of post traumatic stress disorder (PTSD) developing, and to give people the strength to cope at a time when they may feel bewildered, afraid or angry.
In focusing on words like ‘disaster’ we may assume the only time PFA can be employed is by mental health professionals following something huge and devastating happening to a community or country. Whereas PFA may be used be individuals and smaller groups and following any situation that might result in grief or trauma. That could include a relationship breaking down, following a bereavement, dealing with a chonic illness, if someone’s lost their job, or after a traumatic birth. Or supporting friends, loved ones or strangers in the disaster situations outlined above (e.g. during war, when coping with widespread infections, or if you are a refugee or supporting refugee communities). You don’t have to be a trained professional to deliver PFA.
This is easier to understand by noting the five goals of PFA. To provide people with: safety, calm and comfort, connectedness, self-empowerment, and hope. A practical guide on the steps you might want to cover in delivering PFA can be found here (courtesy of the National Centre for PTSD, US). Not all of these are always possible to deliver at the same time, but being able to provide some of them may still be beneficial.
How can media advice givers make use of PFA?
For agony aunts and uncles, we may often be a first port of call when someone is in crisis, or be expected to provide emotional and practical support to those who want advice. Advice columns and programmes can fill an immediate role following disasters or conflict – particularly in the case of radio. But on a general level for those wanting to provide advice via media, learning about the principles and applications of PFA can greatly help when offering advice that empowers and enables others to manage their situations.
This 40-minute talk from the Australian Institute of Professional Counsellors outlines some of the basics of PFA and how to use it
On being a good Psychological First Aider
Following any crisis we may want to take care of others, and as with physical first aid there’s the chance we could save a life if we administer psychological first aid correctly. And equally that we could cause more harm if we get it wrong. To that end it is worth noting what PFA is not. It isn’t: debriefing; taking details of traumatic experiences and losses; offering any kind of treatment, counselling or therapy; or imposing labels or diagnoses.
You don’t have to be a professional to offer PFA. However whether you’re a professional (in healthcare, media or so on) or offering care to a loved one, friend or family member it is vital to remember not to impose any kind of care without asking first. If someone’s experienced a trauma they may want to deal with it in diverse ways and not everyone affected by an emergency will require assistance from you or any other support service. If you’re reaching out to people who are different to you in terms of age, sexualities, genders, culture, faith etc they may understand and respond to their trauma in ways that are not like yours. That is okay and being respectful of this and not pushing your way of coping onto them is important. Just as it is vital to ensure you’re not excluding people from help because you don’t know what to do with them or don’t particularly like who/what they represent. There is an excellent discussion of how trauma and care differs globally (and what can go wrong when we try and impose Western approaches onto other cultures) covered here.
Given how common traumatic events are, it is worth finding out more about what PFA is and how we could use it in our own lives. Links to useful resources and guides can be found at the end of this post. To read through, listen to and reflect on everything here will probably take 15-20 hours so you may want to set aside time to do this or come back to it as and when time permits. Professionals may already be offered PFA as part of their work or may want to take this free online training from John Hopkins University (I would include agony aunts and uncles in this group). Returning to the idea of who may be included or excluded by care, it is worth critiquing all of the references and support materials here to think about who created them, who benefits from them, what models of care are being promoted, and who may be brought in or left out by the way PFA is discussed.
If you’ve used PFA in your own work please share your experiences in the comments – whether it’s helped you or not been effective or if you’ve examples of good practice I’d love to hear them. Particularly from communities across the world, and especially if you can help others help themselves during and after any kind of trauma.
Alongside these tools, if you are health professional dealing with physical health as well as psychological health following disasters or crises you may find the resources from Evidence Aid and Hesperian may benefit you and the communities you work with.
New evidence reviewing PFA guidelines suggests that, following a review of existing guidance, there is no strong evidence currently to show the effectiveness of PFA. This does not mean PFA has no place, more that based on the available evidence cannot pinpoint which is the most effective intervention we might use. Given the aims of PFA are about adapting ideas for individual and community support based on circumstance, culture and place it may be sensible for now to critically use and adapt the resources listed above; while noting potential limitations and finding ways to document any interventions and practices so the process of PFA can continue to be improved upon.
“I’m all at sea”, “I’ve been left high and dry”, “I’ve lost my mainstay”, I’m rudderless”. When it comes to advice giving people frequently draw upon nautical metaphors to explain their situation.
They also talk of needing, or losing, their guiding star. Sometimes putting the agony aunt or uncle into this role, whether they want to be there or not.
In my conversations with established agony aunts (those who’ve been doing the job for 20+ years or longer) most agree not all problems are easy to address, some are impossible to solve, and since the job comes with no training manual very often you’re doing the best you can as you go along. Or as one agony aunt described it “there’s no star to guide me”.
Some months later, when putting this project together, I was thinking about how to illustrate both the experience of seeking advice through the media, and what it felt like to give advice. I returned to the idea of being lost at sea and searching for a star to guide you to a place of safety.
Who can I turn to
When nobody needs me?
My heart wants to know
And so I must go
Where destiny leads me
With no star to guide me
And no one beside me
I’ll go on my way
And after the day
The darkness will hide me
Any maybe tomorrow
I’ll find what I’m after
I’ll throw off my sorrow
Beg, steal or borrow
My share of laughter
With you I could learn to
With you on a new day
But who can I turn to
If you turn away?
I worked with local artist and friend Adam McNaught-Davis to create the image you can see on the homepage. Adam had already created a range of images of the Sussex coastline I liked. I wondered if they could be incorporated into the story of the agony aunt saying she’d no star to guide her.
I’d also been given a gift by my children. A necklace made by Shannon Westmeyer which used an 18th century seal to show cupid searching for the Polar Star, and the inscription ‘if I lose you I am lost’ which brought in the little character in the boat.
All of these came together with the idea of a seascape with someone feeling ‘all at sea’. Over several conversations and at least one bottle of wine we worked with Adam’s sketches and my requests that we included someone who was lost and searching in rough sea, where a coastline was visible to the viewer but not necessarily to the person who was lost. The person in the boat could be of any age, race or gender. And be either the person with the problem or the advice columnist trying to help them. And although our local coastline was featured, the stormy scene could be potentially anywhere in the world.
The aim was for anyone who saw the picture to be able to project their own story onto the picture. They might be able to find the shore (and refuge). But equally they may stay lost and potentially at risk. Outside of advice giving and our picture this is something that remains an issue within the fishing industry which is the most dangerous peace-time occupation to be in, and the loss of fishermen to their families is an often unrecognised tragedy.
Finding ourselves within the seascape
When you use cartooning to represent issues or problems, either overtly as is the case in much modern advice giving or perhaps more subtly as is the case in the illustration for this website, you can find yourself within a picture.
When Adam showed me the drafts of the picture I was struck by the person in the boat. It reminded me of another local landmark. The beautiful Mary Stanford Memorial near Rye Harbour. This was meaningful to me as I accidentally found it many years ago when, following a miscarriage, I’d gone away for a break in Rye to try and not think about it being Mother’s Day weekend. And how I wasn’t one. In the absence of any memorial for the pregnancy I’d lost this became the next best thing.
Adam shared how on looking back at the drawing he sees the ending from the children’s programme In The Night Garden. Perhaps unconsciously influenced by watching this with his young son.
Aside from the ideas I shared with Adam to make the picture, and the references to the sea from agony aunt interviews and people’s writing about their problems, I was able to bring my family history into the picture.
My maternal grandfather was a trawlerman, my grandmother a netbraider. But outside of this both were highly practical people who, if something needed to be done, tended to just get on and do it. Whether that was setting up a youth club or latterly an older people’s community centre. In particular my grandmother was certainly the epitome of a ‘real life’ agony aunt – someone you could share your problems with over the kitchen table with a pot of tea.
Which is perhaps the best way to think about an agony aunt or uncle. Someone you could have a chat with if you needed to. Tea remains optional. Hopefully together you’ll find a safe harbour.
The UK television soap opera Eastenders celebrates its 30th anniversary this week. Which is a good an excuse as any to look at how soap operas can be used to give advice.
What’s a soap opera?
I’m guessing you’ll be familiar with, and perhaps a fan of, soap operas. But if you’re not sure what they are they’re a drama on radio, television, or more recently online. Where interlinking stories show the lives of different characters. Often, although not always, based around a particular town, business or area. The name ‘soap opera’ originates from these early dramas being sponsored by soap manufacturers.
What can soaps offer us?
Aside from entertainment and distraction from every day life, the often unrecognized role of soap operas includes company. The characters in a soap opera and their regular scheduling on TV or radio can either fill the role of family or be an addition to your family. This may be of particular benefit to those who are socially isolated, including stay at home parents, carers, older people, or those who are housebound.
When it comes to advice giving, soaps can play an additional role of education, and outreach. They have been used worldwide through television and radio serials to cover anything from farming advice to dealing with landmines or information about immunization programmes and safer childbirth.
The way advice giving via soap operas has developed is either as a serial specifically developed to raise awareness, usually funded by an NGO or charity – for example New Home, New Life in Afghanistan (radio) or Soul City in South Africa (television). Or where an existing soap opera links with a charity or organization to bring in a particular storyline where an issue is focused on.
This can result in highlighting issues that may not always be noticed or talked about. For Eastenders some storyline examples have included:
Mental distress, mental health problems and break down
Gay and lesbian relationships
Drug and alcohol abuse
Historic child sexual abuse
How are issue-based storylines assumed to work?
The reasoning behind covering a particular issue within a soap opera is primarily to raise awareness. Viewers with a problem may feel less lonely or isolated if they see another character going through what they have experienced. It may alert people that help is available and encourage them to make use of support services, charities or healthcare. Particularly if programmes signpost to other sources of help (websites, telephone helplines etc) at the close of each episode.
People may also be able to model their behaviour based on what they see characters in soaps doing (or decide to do the opposite). While a storyline may make others aware of issues and problems and give them ideas on how to support friends/family who may be in need.
Having characters that audiences relate to going through problems in life may reduce stigma, as viewers or listeners will want their favourite characters to be okay (for example a character to escape a situation of domestic violence). Or familiarize audiences with individuals or issues they may have previously been intolerant about. Such as a gay or lesbian couple, a character with disabilities, a Transgender character, or an ethnic minority family.
A storyline on a particular problem also allows charities or other organisations to talk to other news and entertainment media which both raises the profile of an issue and/or those who are best placed to offer support if it affects viewers. Which in turn might also increase support and donation to charities.
Yes, but do soap operas really manage this?
Criticisms of soaps are they mix so many issues, cliffhangers and melodrama across storylines that particular problem based themes can get missed out or perhaps not taken as seriously as they should be. It’s no coincidence that all the very worst crises in soaps seem to coincide with important holidays or peak viewing times (in the case of Eastenders the Christmas episodes are usually particularly eventful). And with soaps competing between each other for viewing figures, the pressure to find different problems to bring into storylines can mean audiences are fatigued by or inured against topics they may benefit from paying attention to.
The impact of soap opera problem-based storylines on our daily lives has mixed results. Some stories appear to have more of an impact than others. Which can be partly based on how they are portrayed, the popularity of the characters, how convincing the actors are, and how sympathetically audiences respond to characters and issues shown.
Some have argued performances can reinforce, rather than challenge stereotypes For example in Eastenders, Arthur Fowler’s breakdown was greeted with mixed reactions as some felt it showed an overly dramatic and frightening portrayal of mental distress, while others believed it realistically showed someone in crisis.
Or in order to boost ratings, storylines can be embellished in ways that could harm those affected by the very issue they’re trying to raise awareness about. In Eastenders this was most recently shown in the storyline where the character Ronnie Branning experienced the death of her child to SIDS later responded to this trauma by abducting another character’s baby. Unsurprisingly viewers, many of them affected by cot death themselves, angrily reacted to the idea that bereaved parents were unstable, dangerous and a risk to children.
Overall the impact of issue-based storylines tends to be short term. These stories will raise awareness during the time they are being aired, but may not be recalled once the drama has moved on. Moreover knowing that an issue has been covered in a soap does not always relate to any meaningful behaviour change. We might be able to say which character’s been through which problem but we don’t necessarily use that to make any useful changes in our own lives.
Driving attention to charities and services can be a beneficial aspect of issue-based storylines but can also increase the burden on services and charities from people wanting their help. While bringing them no additional financial benefits.
Where charities and NGOs are involved with soap opera storylines they may assume this partnership is enough of an activity and do no further work to evaluate impact or sustain public attention or engagement. They may have the noble idea of ‘increasing awareness’ but have no sense of what that awareness might entail, how to measure its impact, or how to support people once they are more aware of a topic.
When are they effective?
Although issues-based storylines don’t always ‘work’ it would be wrong to dismiss both the popularity of the soap opera generally, and the impact some storylines have had.
While some organisations and media outlets may prefer short-term storylines and impact, for major issues the best way to bring about greater awareness and behaviour change is through ongoing, sustained messaging. Soul City in South Africa is an example of how this can work. It is highly effective both as an entertaining soap that has run for decades but keeps within it core messaging around HIV. One-off storylines can be effective in the short term but don’t tend to have long-term impact.
If you’re working in media, healthcare, or for an NGO or charity and want to introduce an issue to a soap opera you’ll be more likely to make a difference if you:
– diligently research audiences before storylines are introduced to identify specific issues they might be helped to know more about
– develop characters and storylines to appeal to viewers or listeners so audiences can relate to characters going through/representing particular issues and engage more actively with story lines
– make careful links between those with expert understanding of an issue (patient groups/support networks/charities) and those able to translate this into a believable storyline
– support stories with additional materials – a website, cartoon, links to helplines etc
– have clear outcomes for impact from the outset. What behaviour do you want to change and how do you want to change it? If you want to raise awareness how do you want to do this and for what purpose? How can you build this into programming, enable it further through multimedia platforms, and most importantly how will you assess whatever work you do to see what effect storylines have?
As mentioned previously on this site, bad advice giving tends to tell us what to do not how to do it, which is the trap I’ve fallen into above. So, in the tradition of all good soap operas, all of the ideas on how to actually make an issues-based soap opera will be covered in a future episode….
There are numerous different ways people can seek help via the media. Recently I was reading Scarleteen (the sex and relationships advice website) and the different ways they offer direct support for those in need.
Their direct services include:
– Message boards.
– SMS/texting service.
– Live chat service.
– Advice column.
What interests me is how Scarleteen set out for their site users what each of these services involve, how and why they might suit different people at different times, and how quickly replies can be delivered via each service.
If you are considering offering an advice column or perhaps already have an advice service in one form of media you may want to think about whether you could provide advice on one or more of additional formats. Some of these also compliment existing services – for example a SMS/texting service that informs the content of a live radio show on people’s problems. Or a live chat service that can be used after a TV programme on a particular issue has been aired where people can get more information about their specific situation. Or the opportunity to view a website or be sent a help sheet after reading an advice column in a magazine or newspaper.
Offering different services is also dependent on the needs of your audience. So offering an SMS service may be highly effective in some African countries where SMS/texting is popular and access to mobile phones is high. But if your audience is made up of older people who’re not familiar with texting then this wouldn’t be a good use of resources.
The advantages of offering multiple ways to access information and advice means you’ve a better chance of reaching people at different times and in ways that suit them better. If you’re using advice giving to promote a particular issue – for example hand washing, or awareness of a particular infection or vaccination programme – then sharing the same message through a variety of platforms makes it more likely to be heard. Add to this a means for people to be actively involved in a dialogue around issues it’s even more likely your messages might lead to the changes you’re hoping for (e.g. fewer infections or deaths due to poor hygiene).
However this is costly and time consuming to get right. And important to note that providing different ways to deliver messages or enable people to ask for advice is not the same thing as people feeling involved with a service or actually using it or acting on the information shared. So all of this needs careful research and piloting before implementation and a thorough evaluation to see if the services suit your audience and are useful to them.
Whatever you decide you may want to follow Scarleteen’s example of making it clear to your audience not only what services you offer but how they differ from and compliment each other and what you can expect if you use them.
As an agony aunt it’s obvious I’m going to defend advice columns. They’re not just a popular source of entertainment, people do find them genuinely useful. Sometimes even life saving.
However it would be completely wrong to suggest advice columns are all benign or even helpful. It’s worth supporting them when they get things right, and being aware they can get things very wrong.
Here are some of the ways that happens.
1. The advice given tells you what to do but not how to do it. While “luggage label” (very short) replies don’t give enough information to help do anything about your situation.
2. You may write or call in for advice but receive either a standardized answer that doesn’t address your situation. Or get no response at all. Leaving you anxious about whether you’ll ever get reply and potentially feeling rejected and afraid to reach out again, not just to advice columns but to other sources of help and care. This also means a media company is making a profit from your problem.
3. The advice given may not suit your culture, circumstances or situation. For example recommending a relaxing bubble bath as an answer to a serious problem and to someone who has limited access to affordable/hot water. Or recommending someone must immediately and publicly come out as bisexual, lesbian or gay when they’re living in a country where this is illegal and potentially punishable with prison or death.
4. Advice may be outdated, wrong, or dangerous. For example suggesting those who’re depressed just need to ‘think positive’. Or stating those with mental health problems are possessed. Or claiming masturbation causes infertility. Or encouraging people on medication for chronic or life limiting illness to stop taking it. Or recommending people don’t vaccinate their children.
5. Advice can fail to account for difference or diversity – e.g. recommending sex positions unsuitable to someone with mobility problems or chronic pain. Or telling people to make individualistic choices while not noticing they’re in a situation where state, faith or familial control would make this difficult and dangerous, if not impossible.
6. The tone of the advice, or the format of the advice giving column or programme can shame, blame or ridicule those seeking help. If the advice columnist seems judgemental, unsympathetic or overly harsh this can lead to similar reactions from wider audiences towards those in difficulty.
7. The advice columnist may be more interested in promoting their products and services than offering realistic and useful advice for you. While their messages may be commercialized and focused on solutions that are reliant on you having the money to be able to pay. Whether that is in the form of healthcare, therapy, or purchasing products to enhance your relationship (date nights, trips away, sex toys, designer lingerie, expensive bedlinen).
8. The advice columnist may not be paid nor adequately supported or supervised to do their job.
9. Those seeking help may be treated as passive recipients of expert-led (top down) advice rather than giving them tools to find their own solutions to problems or peer-led approaches that actively engage with any advice being given. A focus on all problems as being a huge crisis in need of multiple support interventions may overlook how some people perhaps don’t feel the need for solutions that automatically include follow-up care or to talk widely and in-depth about their experiences. For example the woman who’s had multiple miscarriages that have all upset her to a greater or lesser degree and who wants to share that experience but does not necessarily feel the need to see a therapist about it nor join a self-help group.
10. Examples may be used in advice that are triggering or upsetting (e.g. talking about child abuse recovery by using graphic anecdotes about child sexual behaviour). While images used may reinforce, rather than challenge, problematic ideas about people’s issues. For example the image used at the start of this post is a stock ‘head in hands’ image for ‘depression’.
11. Cases featured, particularly on television (and especially on tabloid talk shows) can demonize those who are poor, from particular racial or tribal groups, who are socially disadvantaged, inarticulate and who may have additional physical or mental health problems or learning difficulties. Rather than offer support for people they may serve to reinforce wider cultural and political views of those in need of assistance as being feckless, immoral, scroungers.
12. Problem pages can change identifiable information but they may not always get this right and potentially you could be identified. For advice programmes on radio and particularly TV you may be easily identifiable if care is not taken to avoid this.
13. Tabloid talk programmes (Maury, Jeremy Kyle etc) may encourage guests to ‘act out’ in ways that may be regretted during and after the programme. Guests may be exposed to stressful, abusive and violent situations, or forced into making choices they don’t feel included in (e.g. ‘choose now to go into therapy or we won’t help you any more’). While aftercare for advice columns and programmes is mostly non-existent and where it does exist it varies in quality and has never been evaluated for effectiveness. Services used within programmes may compound people’s difficulties. For example using lie detectors or ‘interventions’ (where friends or family confront a person to tell them how much of a problem their problems are causing).
14. Some agony aunts are more interested in being famous and/or talking about their own issues than those of their audience.
15. Increasingly advice giving happens via email, online, or through smart phones. If you don’t have access to the right technology you may not be able to ask for the help you need.
16. Problems can be individualized through advice giving. Solutions offered are around the person with a problem either seeking further care or looking to improve themselves. Rather than encouraging audiences to look at wider cultural, structural or social issues that are causing or exacerbating their problems. You may well feel unhappy and a course of counselling might help, but it won’t change much if you are still living in a damp home where you cannot afford food and are struggling with breathing difficulties.
17. Supporters of advice columns argue they challenge or subvert the status quo. In many cases they may maintain it, or worse still present a commercialized and aspirational view of the world where those in crisis are there to be laughed at, pitied, shamed or punished.
18. If you’ve literacy or communication problems reading or contacting advice columns may be particularly difficult.
19. Searching for information or asking for help on taboo topics may be highly risky in some cultures – for example asking for advice about sexuality, or abortion, simply trying to access reproductive health services if you are a young person or unmarried, searching for information about domestic violence, or trying to get help without your husband or in-law’s permission.
20. Writing about your experiences or expressing them on radio or TV may leave you feeling more upset or anxious than before you asked for help.
21. You may simply not have the reserves, energy or confidence to act on the advice given. Which in turn may leave you feeling more helpless and hopeless.
22. Although it’s often recommended, particularly when justifying the importance of advice columns, passing your secrets on to someone else doesn’t always make you feel better, nor lead to anything changing in your life.
23. You may feel cheated if the person you ask for help from doesn’t give you the answers you want. And sometimes there are no immediate solutions to problems.
24. Problems are often presented in a narrative of hope and recovery where audiences are expected to ‘get better’ or ‘change’. But where no notice is given to how difficult this may be, and how other social, cultural and historical factors may prevent this. For example the person upset about being single is expected to try harder and transform themselves into dating material. The alcoholic or drug user is expected to want to stop using immediately and get sober. The person in an abusive relationship is expected to recognize abuse and to leave, quickly. Where people resist or find this hard they are seen as being difficult, weak or unwilling to want to help themselves. And therefore completely to blame for their situation.